Act 39 Overview
KEY FEATURES OF THE LAW
Act 39, Vermont’s Patient Choice at End of Life law, allows a capable, terminally ill, adult patient to request and obtain a prescription for medication to be self-administered for the purpose of hastening the patient’s death. Participation in the law is voluntary for patients, health care facilities and providers. A patient who obtains a prescription for the intended purpose of hastening death may change his or her mind at any time. Link to Text of Act 39. Link to 2022 Amendment S.74.
The Vermont Department of Health issues periodic reports to the legislature. They report that since the adoption of the law in 2013, forms were filed for 116 patients who qualified under the law. Link to the 2018 report. Link to the 2020 report. Link to the 2022 report. Link to the 2024 report.
Act 39, Vermont’s Patient Choice at End of Life law, allows a capable, terminally ill, adult patient to request and obtain a prescription for medication to be self-administered for the purpose of hastening the patient’s death. Participation in the law is voluntary for patients, health care facilities and providers. A patient who obtains a prescription for the intended purpose of hastening death may change his or her mind at any time. Link to Text of Act 39. Link to 2022 Amendment S.74.
The Vermont Department of Health issues periodic reports to the legislature. They report that since the adoption of the law in 2013, forms were filed for 116 patients who qualified under the law. Link to the 2018 report. Link to the 2020 report. Link to the 2022 report. Link to the 2024 report.
Act 39 Qualifications and Process:
Fundamental to the structure of Act 39 is a comprehensive set of requirements and a carefully prescribed process designed to ensure that legalized aid in dying is only available to those who are near death, competent to decide, and who have made the decision to request this assistance. The system is comprised of:
Fundamental to the structure of Act 39 is a comprehensive set of requirements and a carefully prescribed process designed to ensure that legalized aid in dying is only available to those who are near death, competent to decide, and who have made the decision to request this assistance. The system is comprised of:
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Note: Legislation passed into law effective May 2, 2023 removed all Vermont residency requirements. All other qualifications remain unchanged. Non-Vermont residents are advised to go to the page For Non-Residents first for relevant advice and information. A. Qualification Requirements: The patient must a. Be able to make and communicate their medical decisions, b. Have a terminal condition which would, within reasonable medical judgment, result in death within six months, c. Be making an informed and voluntary request, and d. Be able to self-administer the medication. B. Mandatory Process: The patient and the physician must follow a specific process. a. The doctor must confirm that all of the qualification requirements have been met. The prescribing doctor must either conduct or review the medical record of a physical examination of the patient. The doctor may determine the requirement of capability him or herself, or may refer the patient for evaluation by a psychiatrist, psychologist or clinical social worker for this purpose. b. The patient must make two oral requests at least fifteen days apart in the physical presence of the doctor or by video telemedicine if the doctor determines telemedicine to be clinically appropriate. c. The patient must make a written request signed by the patient in the presence of two or more witnesses who are not interested persons, who were at least 18 years of age, and who signed and affirmed that the patient appeared to understand the nature of the document and to be free from duress or undue influence at the time the request was signed. d. The doctor must offer the patient the opportunity to rescind the request and inform the patient that the request may be rescinded at any time. |
B. Mandatory Process (cont): e. The doctor must also inform the patient of the diagnosis, prognosis, availability of hospice and other end-of-life treatment and care options, the risks and results of taking the medication. f. If applicable, the doctor must consult with the patient's primary care physician with the patient's consent. g. A second physician must confirm the diagnosis, prognosis, and verify that the patient is capable, was acting voluntarily, and had made an informed decision. h. After all the requirements are met, the prescription can be written. With the passage of S.74 in 2022, there is no longer a final 48-hour delay. C. Documentation: The prescribing physician must document in the patient’s records that all the qualification and process requirements have been met and the prescribed forms must be filed with the Vermont Department of Health. D. Entirely Voluntary The patient may decide at any time to rescind the request, fill or not fill the prescription and take or not take the medication. Participation is also voluntary for medical personnel and health care facilities. |
Reporting: After writing the prescription, the physician must promptly file a report with the Department of Health documenting completion of all of the requirements under this statute. Please see the following forms:
- Vermont Department of Health End-of-Life Choice: Physician Reporting Form
- Vermont Department of Health End-of-Life Choice: Consulting Physician Reporting Form
- Vermont Department of Health End-of-Life Choice: Prescribing Physician Follow up Form
- Vermont Department of Health End-of-Life Choice: Patient Request for Medication Form
MORE HELP FOR PATIENTS AND HEALTHCARE PROFESSIONALS
Patient Choices Vermont provides the following guides:
Guide to Medical Aid in Dying and End-of-Life Decision Making: Provides a concise outline of the basic requirements of Act 39.
How to Talk to Your Doctor: Discusses the importance of early conversations with your doctor about medical aid in dying under Act 39 and offers suggestions on how to have those conversations.
Frequently Asked Questions: Answers questions that people often ask about Act 39.
Glossary of Terms: Provides definitions of terms related to end-of-life choice.
Guide to Medical Decision-Making: Suggests a decision-making process and questions to guide you in case of serious illness.
Guide to Advance Care Planning for Dementia: Offers directives that can be included in advance directives to address the possibility of dementia.
Clinician's Guide: Includes important links and sources for information.
For Non-Residents: Provides advice and information on how non-Vermont residents may meet the requirements to access Act 39 in Vermont.
DEPARTMENT OF HEALTH GUIDANCE
The Department of Health has published forms and guiding materials for interested patients and medical providers. They are available here.